PCSH IT Acknowledgement Form

Desktop/Laptop/Equipment Acknowledgement Form

No.	Brand & Model	Serial Number	Type	Action

In acknowledgement of the acceptance of the itme/items listed above in a good condition. I hereby agree to bear responsiblity for the safekeeping of the item/items listed above and be bond by the terms condition set forth. If the item/items are lost or stolen due to negligence on part of the employee, the replacement of the new item(s) will be borne by the employee concerned.

Name: Staff ID: Email:

Department: Date:

Signature:

Desktop/Laptop/Equipment Acknowledgement Form

Received By: